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Emergency Radiology

, Volume 25, Issue 2, pp 121–127 | Cite as

Clinical and imaging features in lung torsion and description of a novel imaging sign

  • Mark M. Hammer
  • Rachna Madan
Original Article
  • 243 Downloads

Abstract

Purpose

We set out to identify the clinical and imaging features seen in lung torsion, a rare but emergent diagnosis leading to vascular compromise of a lobe or entire lung.

Methods

We retrospectively identified 10 patients with torsion who underwent chest CT. We evaluated each case for the presence of bronchial obstruction and abnormal fissure orientation. In seven patients who underwent contrast-enhanced CTs, we assessed for the presence of the antler sign, a novel sign seen on axial images demonstrating abnormal curvature of the artery and branches originating on one side.

Results

Five patients had right middle lobe (RML) torsion after right upper lobectomy, and the remaining occurred following thoracentesis, aortic surgery, or spontaneously. Chest CTs demonstrated bronchial obstruction in eight cases and presence of abnormal fissure orientation in four patients. The antler sign was present in three patients with whole-lung torsion and one patient with lobar torsion; vascular swirling was seen on 3-D images in all seven patients with contrast-enhanced CTs.

Conclusions

Lung parenchymal imaging findings in lung torsion may be non-specific. Identification of the antler sign on contrast-enhanced chest CT, in combination with other signs such as bronchial obstruction and abnormal fissure orientation, indicates rotation of the bronchovascular pedicle. The presence of this sign should prompt further evaluation with 3-dimensional reconstructions.

Keywords

Lung torsion Lobar torsion Lung resection CT pulmonary angiogram 3D reconstruction 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© American Society of Emergency Radiology 2017

Authors and Affiliations

  1. 1.Department of Radiology, Brigham and Women’s HospitalHarvard Medical SchoolBostonUSA

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